A Prospective Study of the Requirement for and the Provision of Epilepsy Surgery in the United Kingdom


Address correspondence and reprint requests to Dr. S.D. Lhatoo at Department of Neurology, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol BS6 7AB, U.K. E-mail slhatoo@aol.com


Summary:  Purpose: Of the 30,000 persons in whom epilepsy develops annually in the United Kingdom, in ∼6000 (20%), intractability develops. Some of these patients will be appropriate for epilepsy surgery. We aimed to estimate the number of patients who should be considered surgical candidates, by extrapolation from a population-based study of prognosis and the number who are receiving epilepsy surgery, by a survey of U.K. neurosurgeons.

Methods: We identified the number of patients who may eventually require surgery from a prospective cohort of patients with newly diagnosed epilepsy. We identified all U.K. neurosurgeons who had performed any epilepsy surgery in the past year. Each identified surgeon prospectively recorded the number and types of operations carried out for 6 months.

Results: Of newly diagnosed patients each year, 450 (1.5%) may eventually require surgery. Thirty-two respondents (22% of all U.K. neurosurgeons) reported that they performed epilepsy surgery. The 211 operations were carried out in the 6 months surveyed (422 operations annually or 13 per surgeon per year). Temporal lobe resection (77%) was the most common procedure.

Conclusions: Based on a prevalence of 5/1,000 persons with epilepsy, ≤4,500 patients in the U.K. require epilepsy surgery. Every year, 450 patients with newly diagnosed epilepsy who may eventually require surgery are added to this “surgical pool.” At the current annual rate of operations, a large number of refractory patients remain untreated. This is probably partly because many patients are not referred for specialist care and therefore remain underinvestigated.